Headache in Giant Cell Arteritis – A Classic Symptom

Giant Cell Arteritis is a disease that affects the arteries in the head, particularly temples. It is the most common type of vasculitis in people over 50 years of age thus the abrupt onset of a Headache in Giant Cell Arteritis is a classic symptom that can lead towards the diagnosis of the disease in old patients. The disease is curable with proper treatment but if left untreated this can lead to permanent blindness.

• Location and Character of pain
• Symptoms
• Causes
• Complications
• Risk factors
• Diagnosis
• Treatment
• When to Consult the doctor

Location of pain

Pain is particularly felt in the temples because temporal arteries are affected.

Character of pain

Headache in Giant Cell arteritis is throbbing in character and is mostly continuous. The pain is accompanied by scalp tenderness.

Symptoms

Since the disease affects arteries in the head so the symptoms are mostly confined to that area, some of these are:

• Headache in temples
• Tender to touch
• Bulging, nodular, pulsating, and twisted arteries in the temples
• Edema and redness of the scalp in the temples which can result in loss of pulse in that area.
• Blindness in one eye
• Nausea and vomiting
• Fever and fatigue
• Abrupt weight loss
• Dry cough and other respiratory symptoms

Causes

The exact cause of Giant Cell Arteritis is still unknown, however, most researches and studies link the inflammation with genetic factors and infections. The immune system of the body activates in response to an infection and invades the normal healthy cells causing a build-up of “Giant cells” in the arteries. These Giant Cells further produce chemicals that destroy the arterial walls and cause inflammation. The inflammation in the temporal arteries results in constant pulsations and thus a throbbing Headache in Giant Cell Arteritis. The headache also affects the frontal branches of the temporal artery.

Complications that can develop in Giant Cell Arteritis

• Partial blindness in one eye that can affect the other eye as well with complete loss of vision if left untreated
• Thinning of the arterial wall leading to arterial dissection
• Increased risk of aneurysms
• Increased risk of stroke
• Inflammation can spread to other arteries as well mainly, Aorta

Risk factors

• Old age
• Female gender
• According to some researches, the disease mostly affects people with northern or Caucasian descent.

Diagnosis

The diagnostic criteria include 3 following symptoms to be present for it to be classified as Giant Cell arteritis:

• Abrupt onset of headache that is localized to temples
• Age equal to or more than 50 years
• Increased erythrocyte sedimentation rate

Confirmation of diagnosis depends upon:

• Biopsy of arteries that is done after 14 to 15 days of treatment.
• Ultrasound or MRI for early diagnosis.
• Other than this ophthalmological examination is also required with exclusive attention paid to the Optic nerve and Central Retinal artery.

Treatment

• Mostly it is self-limiting but requires symptomatic treatment.
• High dose steroid therapy is started in patients who have visual symptoms along with Headache in Giant Cell arteritis.
• Prednisolone or any other steroid is given for 15 days.
• Actemra(Tocilizumab) for patients who experienced relapses with steroid therapy.
• Tumor necrosis factor inhibitors.

When to Consult the Doctor

In case of abrupt onset of a headache that is localized to the temples and is accompanied by some visual symptoms, you should book an appointment with the doctor as soon as possible.

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